Determining The Potentially Multiple Sources of Inattentive Behavior

There is growing empirical support that nutrition has an important role to play in attention/concentration and in learning. The balance between noradrenalin and serotonin is critical to mood, attention and behavior and that the food we consume is an important factor in maintaining this balance. Food additives may be used in order to influence behavior in the future. Yet, such practices are already occurring and some provocative research has recently been completed that is highly suggestive that nutritional interventions can have a profoundly positive impact on children’s learning.

Nutritional Interventions and Attention

By correcting the nutritional imbalance of omega three fatty acids, some children are better able to attend and concentrate. Correcting nutritional imbalances can result in significant improvements in ADHD symptoms. But some of the best known ADHD researchers have been very critical of claims that diet plays an important role in brain function, behavior and attention.

Diet adversely affects some children’s attentional behaviors, sometimes dramatically. Some studies focused on the effects of artificial colors, dairy, corn and other common foods. They make a strong case for parents and health care professionals to use nutritional assessments/interventions before resorting to psychostimulants and for psychologists to increase their understanding of the important connections between nutrition, health and learning.

As school psychologists, it can make sense to include questions about a child’s basic nutritional habits in our clinical interview. For example, a child who skips breakfast, has a caffeinated drink and a candy bar at midmorning and a burger and fries at lunch is likely to be struggling with some important nutritional deficiencies.

Cola consumption: Drinks sweetened with aspartame instead of sugar may cause a tryptophan deficiency, leading to a reduction in serotonin levels and to depression.

Caffeinated drinks decrease learning among children and adolescents. Caffeinated soft drinks can also lead to pediatric hypertension. So, while caffeine can leave one feeling more aroused, one is not better prepared for learning and concentrating.

Need for water: Water is critical to attention, learning and good health and that many children need more water than they are presently consuming. For nerves and muscles to function properly, the balance between water and electrolytes need to be maintained. Insufficient water intake can decrease this polarity among cell membranes which can make it more difficult to focus. Water assists the body in delivering oxygen to the brain which is critical for learning. We need about a quart of water per one hundred pounds of body weight each day.

Marketing versus nutrition: Despite the potential health risks associated with soda (the sugar, aspartame and caffeine), schools are working with cola companies to fund a variety of school activities in exchange for access to the vulnerable school children who will consume these unhealthy beverages. It is big business.

School Psychologists and Nutrition: So, what can we do as psychologists working with children and adolescents who have attentional problems? We can refer the child’s parents to health care professionals who are knowledgeable in the areas of nutritional assessment and treatment. Some physicians have the necessary training to address the technical aspects of nutritional deficiencies and/or environmental toxins.

There are a number of recommendations that we can make regarding nutrition that would be both safe and responsible, even though we’re not trained as nutritional “experts.” It would be reasonable to recommend to the child’s or adolescent’s parents that a well-rounded diet be provided — to include sufficient amounts of carbohydrate, protein and even the essential fatty acids.

The consumption of sugar and caffeine should be reduced or even eliminated and most agree that highly refined foods should be replaced with whole grains and less processed foods.

Medical Sources of Inattention

Being ill is an obvious stressor that can interfere with a child’s or adolescent’s ability to remain attentive. Up to ten percent of all children under ten years of age and up to fifteen percent of all adolescents experience headaches in school that can be a deterrent to well-focused work.

Lead or pesticide poisoning can lead to symptoms of ADD. Medical maladies that can lead to attentional problems include diabetes and heart disease. Children all too often experience very superficial exams and are then placed on methylphenidate to quiet the symptoms and the real problem goes undiagnosed.

Importance of comprehensive evaluation: Clearly, when school psychologists refer children to physicians, we need to advocate for comprehensive exams to be completed. The health insurance system has evolved to the point that it discourages and sometimes even inhibits physicians from completing such full evaluations.

Most managed care systems are capitated, which means that physicians receive a set fee each year for treating a group of patients. There are significant financial incentives for limiting expensive diagnostic procedures.

When thorough physical examinations are performed that identify organic, medical causes of inattention, then appropriate interventions can be provided. The full medical evaluation may lead to a specific problem that can be treated, or it may rule out a medical source for the inattentiveness. That is important information, too, in our search for ways to help the inattentive child.

Orthomolecular medicine: The orthomolecular medicine is an attempt to address biochemical imbalances in the body. It works to diagnose, and then treat, deficiencies or excesses of nutrient molecules and to rid the body of any detectable toxins. Some of the physiological causes of attentional problems or hyperactivity are amino acid deficiencies, vitamin B deficiencies, mineral and essential fatty acid deficiencies, food additive allergies, heavy metals toxicity, thyroid disorders and a highly refined, carbohydrate diet.

Making a diagnosis of ADHD based on behavioral symptoms described on behavior rating scales, and then prescribing psychotropic medication without identifying underlying physiological risk factors is not good medicine.

Medication interventions: The prescription of Ritalin or other psychotropic drugs for attentional problems has become controversial for a number of reasons. Drugs can mask the symptoms that are indicative of a variety of potential disorders. Children who take Ritalin can become isolated, withdrawn, over focused, quiet, still and zombie-like.

Treatment with methylphenidate leaves the individual significantly more vulnerable than peers to becoming dependent on nicotine (smoking) and cocaine. Psychotropic drugs have their effect on behavior through their toxicity. Ritalin reduces blood flow to the brain by 23 to 30 percent. It should be pointed out that some psychiatrists believe that treatment with psychostimulants can actually protect patients from abusing alcohol and drugs.

Ecological Considerations and Attention

Quality relationships: The quality of a child’s or adolescent’s relationship with adults may be the single most important contextual factor in their growth, development, behavior and even their ability to attend and concentrate. Carlson et al. The quality of caregiving is a more powerful predictor of distractibility than biological factors or the child’s temperament.

A word of caution regarding this emotionally charged issue: Clearly, some highly responsive parents have children with problems of inattention — this contextual factor is only one of many possibilities when assessing attentional problems.

Contextual factors do play a role in attentional problems for some children. What children need most are meaningful relationships with adults. A history of trauma can make it more difficult to be attentive. To deal with the effects of trauma, it is necessary for children to feel safe, to find “sanctuary” within the context of compassionate and caring individuals.

Children with reduced time with parents or other compassionate adult caregivers are at increased risk for a variety of pscho-social problems. The evolution of the family over the last twenty-five years has decreased the amount of time available for children and parents to be together.

The structure of the family has changed so that half of all children spend time in a single parent household and births to single mothers has escalated from five percent in 1960 to 39.8 percent in 2022 (Source here: https://www.statista.com/statistics/276025/us-percentage-of-births-to-unmarried-women/).

The problem is not the family structure, it is the increased risk of social-emotional stressors inherent in single parenting which can include diminished financial resources and diminished time for parents and children to be together in a stress-free climate.

Technology and inattention: One of the many problems with television and the Internet is that it deprives people of time spent together and relating to each other. There are other problems that stem from watching television.

The combination of television, video games, cell phones and computers lead children to need progressively higher levels of sensory stimulation to the point that it becomes difficult for them to settle in to periods of quiet, slow and reflective, well-focused study.

School context: Many make the case that the school context is a mismatch for some, even many children/adolescents. Our enculturation of boys prepares them poorly for school. Educators are all too often unaware of the emotional needs of boys and that the active expression of these unmet needs can be mistaken as a disorder of attention. Boys often express themselves by action and behavior rather than by language. Most children who have experienced trauma also express themselves via action rather than in words. This expression through action can be easily misunderstood as some type of attentional problem or as ADHD.

Novelty and movement: Children and adolescents have no trouble paying attention in a context of sufficient novelty. Children especially, but even adolescents, need to move. The areas of the brain that are important in terms of attention require movement to develop.

A Holistic Approach

As psychologists, we can encourage caring adults to spend more time with children, perhaps through mentoring programs and after school programs. We can encourage children and parents to spend more time in nature where there is less of an assault on the senses from video games and other forms of technology.

We can encourage children and parents to be more aware of the importance of good sleeping practices, good nutrition, regular exercise, relaxation and supportive relationships in improving attention and learning in general.

We can provide opportunities for the verbal, musical or artistic expression of painful life events and, importantly, encourage educators to provide opportunities for movement.

In summary, determining the potentially multiple sources of inattentive behavior is a daunting task. We believe that the process requires a holistic perspective of human behavior and a comprehensive and integrative process of treatment.

Megan Wilson is a teacher, life strategist, successful entrepreneur, inspirational keynote speaker and the Development Manager for https://DtiCorp.com/. Megan champions a radical rethink of our school systems; she calls on educators to teach both intuition and logic to cultivate creativity and create bold thinkers.